Final_Exam_Nursing_101 Practice Questions
3.A client in his 40s has asked the nurse how much sleep he should be getting in order to maximize his health and wellbeing.
How should the nurse respond?
A) “Most adults need between seven and nine hours, but everyone is different.”
B) “It’s important to get a minimum of eight hours sleep each night.”
C) “More sleep equals better health, so the more sleep you can fit into your schedule, the better.”
D) “Sleep needs depend a lot on age, and at your age, six to seven hours usually suffice.”
4.Which of the following clients likely faces a risk for the nursing diagnosis of Disturbed Sleep Pattern: Difficulty Remaining Asleep?
A) A client who receives IV antibiotics every three hours
B) A client whose opioid analgesics result in central nervous system depression
C) A client who is receiving corticosteroids that make her feel restless and agitated
D) A client whose physical therapy has been scheduled in the late evening
5. Which group of terms best describes sleep?
A) Decreased state of activity, refreshed
B) Altered consciousness, relative inactivity
C) Comatose, immobility
D) Alert, responsive
6. An individual awakens from a sound sleep in the middle of the night because of abdominal pain. Why does this happen?
A) Stimuli from peripheral organs to the RAS
B) Stimuli to the wake center in the cerebral cortex
C) Messages from chemoreceptors to the brain
D) Messages from baroreceptors to the spinal cord
7.A nurse is caring for a client who is sleeping for abnormally long periods of time. This condition may be caused by injury to which of the following body structures?
A) Spinal cord
B) Pancreas
C) Hypothalamus
D) Thyroid
8. What name is given to the rhythmic biologic clock that exists in humans?
A) Sleep-wake cycle
B) Alert-unaware process
C) Circadian rhythmD) Yo-yo theory
9.A nurse working the night shift assesses a client’s vital signs at 4 a.m. (0340). What would be the expected findings, based on knowledge of NREM sleep?
A) Decreased TPR and BP
B) Increased TPR and BP
C) No change from daytime readings
D) Highly individualized, cannot predict
10.A nurse educates a young couple on putting their newborn on his back to sleep. What is the rationale for this information?
A) Prone position increases the risk for sudden infant death syndrome.
B) Prone position decreases the risk for sudden infant death syndrome.
C) Supine position may alter the size and shape of the infant’s head.
D) Supine position makes changing diapers and feeding difficult.
11.Based on the circadian cycle, the body prepares for sleep at night by decreasing the body temperature and releasing which chemical? A) Neonephrine
B) Seratonin
C) Melatonin
D) Dopamine
12.A middle-age adult man has just started an exercise program. What would the nurse teach him about timing of exercise and sleep?
A) Exercising immediately before bedtime enhances ability to sleep
B) Exercising within two hours of bedtime can hinder ability to sleep
C) The time of day does not matter; exercise facilitates sleep
D) The fatigue from exercise may be a hindrance to sleep
13. Which medication is least likely to affect sleep quality?
A) Diuretic
B) Steroid
C) Antidepressant
D) Ambien
14. Which individual is likely to require more hours of sleep?
A) a person 75 years of age
B) a person 43 years of age
C) a person 25 years of age
D) a person 15 years of age
15.A client’s bed partner reports the client often has irregular snoring and silence followed by a snort. Does this warrant further assessment?
A) No, snoring has varied patterns
B) No, this is a description of normal snoring
C) Yes, this is an indicator of obstructive apnea
D) Yes, the bed partner is unable to sleep at night
16. Which of the following is the most common sleep disorder?
A) Hypersomnia
B) Parasomnia
C) Insomnia
D) Dyssomnia
17.A client who has a sleep disorder is trying stimulus control to improve amount and quality of sleep. What is recommended in this type of therapy?
A) Use the bedroom for sleep and sex only.
B) Use the bedroom for reading and eating.
C) Go to bed at the same time every night.
D) Sleep alone with minimal coverings.
18. A client is diagnosed with narcolepsy. Which of the following is a characteristic of this disorder?
A) Waking during sleep
B) Restless leg syndrome
C) Uncontrollable desire to sleep
D) Decrease in the amount or quality of sleep
19. A client with a sleep disorder experiences cataplexy. Which is a feature of this condition?
A) Irresistible urge to sleep, regardless of the type of activity in which the client is engaged
B) Sudden loss of motor tone that may cause the person to fall asleep; usually experienced during a period of strong emotion
C) Nightmare or vivid hallucinations experienced during sleep time
D) Skeletal paralysis that occurs during the transition from wakefulness to sleep
20. What is the rationale for using CPAP to treat sleep apnea? A) Positive air pressure holds the airway open.
B) Negative air pressure holds the airway closed.
C) Delivery of oxygen facilitates respiratory effort.
D) Alternating waves of air stimulate breathing.
21.The parents of a boy 10 years of age are worried about his sleepwalking (somnambulism). What topic should the nurse discuss with the parents?
A) Sleep deprivation
B) Privacy
C) SchoolworkD) Safety
22. What independent nursing action can be used to facilitate sleep in hospitalized clients who are on bedrest?
A) Administering prescribed sleep medications
B) Changing the bed with fresh linens
C) Encouraging naps during the daytime
D) Giving a back massage
23.A sedative-hypnotic has been prescribed to help a client sleep. What should the nurse teach the client about this medication?
A) It should be taken every night for several months
B) It is useful for sleep but is better taken with alcohol
C) It loses its effectiveness after one or two weeks
D) It should be taken in the morning for long-term effects
24. What is the most common method for ordering sleep medications?
A) Stat
B) p.r.n
C) Single order
D) Daily dose
25.What condition have studies confirmed occurs when adults and children do not get recommended hours of sleep at night? A) Obesity
B) Anxiety
C) Diabetes
D) Hypertension
26. Which drug normalizes sleep cycles by enabling the body’s supply of melatonin to naturally promote sleep?
A) Flurazepam (Dalmane)
B) Temazepam (Restoril)
C) Eszopiclone (Lunesta)
D) Ramelteon (Rozerem)
27. Which expected outcome demonstrates the effectiveness of a plan of care to promote rest and sleep?
A) Verbalizes inability to sleep without medications
B) Continues to read in bed for hours each night
C) Identifies factors that interfere with normal sleep pattern
D) Reports minimal improvement in quality of rest and sleep
28.A nurse is caring for a client who has been diagnosed with insomnia. What nursing intervention would help the nurse relieve the client’s condition? A) Maintain a calm and quiet environment free from noise.
B) Administer sedatives as prescribed by the physician.
C) Motivate the client to sleep because it may affect his health.
D) Engage the client in some diversional activities.
29.A nurse is caring for a client diagnosed with sleep apnea. What should the nurse do in order to promote sleep in the client? A) Encourage the client to lose weight.
B) Avoid sedatives for sleeping.
C) Encourage deep breathing exercises.
D) Provide good ventilation in the room.
30.A nurse is caring for a client who complains about sleep apnea. Which of the following delivery devices should the nurse use to administer oxygen to this client? A) Nasal catheter
B) Oxygen tent
C) Transtracheal oxygenD) CPAP mask
31. Which of the following guidelines does the nurse apply to discussion of sleep patterns with older adult clients? A) Circadian rhythms become more prominent as clients age.
B) The amount of stage 4 sleep increases as clients age.
C) Total sleep time decreases as the clients age.
D) Older clients fall asleep more quickly than younger ones.
32.A client has sought care because of insomnia that has been increasing in severity and frequency in recent months. What questions should the nurse include in an assessment of this client’s health problem? Select all that apply. A) “Do you have a family history of sleep disturbances?”
B) “Do you smoke?”
C) “What medications are you currently taking?”
D) “Do you have a consistent routine around getting ready for bed and going to bed?”
E) “How would you characterize your mood lately?”
33.A new mother is discussing her 6-month-old infant’s sleep habits and expresses concern about the infant obtaining too much sleep. The mother reports the infant’s circadian cycle as:
Time period Activity 0600-0900 awake
0900-1100 sleep
1100-1300 awake
1300-1600 sleep
1600-1900 awake
1900-2200 sleep
2200-2400 awake
2400-0600 sleep
The best statement by the nurse is:
A) “Your infant requires more time asleep during the day hours.”
B) “You need to awaken your infant during the 2400 to 0600 time period.”
C) “Your infant is obtaining the average hours of sleep per day for an infant.”
D) “Your infant is actually obtaining too little sleep for one day.”
34.The nurse manager in an acute care facility has received client evaluations in which the clients have complained about excessive noise that interfered with their rest. The nurse manager and nursing staff plan to do the following.
Which activity will most assist clients in obtaining rest?
A) Post signs for quiet and turn down hall lights during formal quiet times.
B) Ensure clients are offered prescribed sleeping medications at bedtime.
C) Provide a small carbohydrate snack or juice prior to hours of sleep.
D) Adjust the temperature of the room to 74 degrees and provide a blanket.
35.The client is a male who states his wife complains that his snoring awakens her at night. The spouse is present. To obtain further data, the nurse asks the spouse what? A) “How loud is his snoring?”
B) “Is there silence after snoring which then is followed with a snort?”
C) “How long does he snore each night?”
D) “How often are you awakened at night due to his loud snoring?”
Chapter 34, Comfort and Pain Management
1.A cyclist reports to the nurse that he is experiencing pain in the tendons and ligaments of his left leg, and the pain is worse with ambulation. The nurse will document this type of pain as which of the following?
A) Somatic pain
B) Cutaneous pain
C) Visceral pain
D) Phantom pain
2. Which statement accurately describes pain experienced by the older adult? A) Boredom and depression may affect an older person’s perception of pain.
B) Residents in long-term care facilities have a minimal level of pain.
C) The older client has decreased sensitivity to pain.
D) A heightened pain tolerance occurs in the older adult.
3.Pet therapy is commonly used in long-term facilities for distraction. If a client is experiencing pain and the pain is temporarily decreased while petting a visiting dog or cat, this is an example of which type of distraction technique? A) Tactile kinesthetic distraction
B) Visual distraction
C) Auditory distraction
D) Project distraction
4. Of the following individuals, who can best determine the experience of pain?
A) The person who has the pain
B) The person’s immediate family
C) The nurse caring for the client
D) The physician diagnosing the cause
5. A client who has breast cancer is said to be in remission. What does this term signify? A) The client is experiencing symptoms of the disease.
B) The client has end-stage cancer.
C) The client is experiencing unremitting pain.
D) The disease is present but the client is not experiencing symptoms.
6. Which of the following clients would be classified as having chronic pain?
A) A client with rheumatoid arthritis
B) A client with pneumonia
C) A client with controlled hypertensionD) A client with the flu
7.A client has a severe abdominal injury with damage to the liver and colon from a motorcycle crash. What type of pain will predominate? A) Psychogenic pain
B) Neuropathic pain
C) Cutaneous painD) Visceral pain
8.A client in the emergency department is diagnosed with a myocardial infarction (heart attack). The client describes pain in his left arm and shoulder. What name is given to this type of pain?
A) Cutaneous pain
B) Referred pain
C) Allodynia
D) Nociceptive
9. Why is acute pain said to be protective in nature?
A) It warns an individual of tissue damage or disease.
B) It enables the person to increase personal strength.
C) As a subjective experience, it serves no purpose.
D) As an objective experience, it aids diagnosis.
10.A client tells the nurse that she is experiencing stabbing pain in her mouth, gums, teeth, and chin following brushing her teeth. These are symptoms of which of the following pain syndromes?
A) Complex regional pain syndrome
B) Postherpetic neuralgia
C) Trigeminal neuralgia
D) Diabetic neuropathy
11.A nurse implements a back massage as an intervention to relieve pain. What theory is the motivation for this intervention? A) Gate control theory
B) Neuromodulation
C) Large/small fiber theory
D) Prostaglandin stimulation
12.A client has been taught relaxation exercises before beginning a painful procedure. What chemicals are believed to be released in the body during relaxation to relieve pain?
A) Narcotics
B) Sedatives
C) A-delta fibers
D) Endorphins
13. How may a nurse demonstrate cultural competence when responding to clients in pain? A) Treat every client exactly the same, regardless of culture.
B) Be knowledgeable and skilled in medication administration.
C) Know the action and side effects of all pain medications.
D) Avoid stereotyping responses to pain by clients.
14. Which client would be most likely to have decreased anxiety about, and response to, pain as a result of past experiences? A) One who had pain but got adequate relief
B) One who had pain but did not get relief
C) One who has had chronic pain for years
D) One who has had multiple pain experiences
15. Which misconception is common in clients in pain?
A) “I will get addicted to pain medications.”
B) “I need to ask for pain medications.”
C) “The nurses are here to help relieve the pain.”
D) “I do not have to fight the pain without help.”
16. What is the term used to describe a pharmaceutical agent that relieves pain?
A) Antacid
B) Antihistamine
C) AnalgesicD) Antibiotic
17.A client with cancer pain is taking morphine for pain relief. Knowing constipation is a common side effect, what would the nurse recommend to the client?
A) “Only take morphine when you have the most severe pain.”
B) “Increase fluids and high-fiber foods, and use a mild laxative.”
C) “Administer an enema to yourself every third day.”
D) “Constipation is nothing to worry about; take your medicine.”
18. Which client would benefit from a p.r.n. drug regimen?
A) One who had thoracic surgery 12 hours ago
B) One who had thoracic surgery four days ago
C) One who has intractable painD) One who has chronic pain
19.A nurse is teaching an alert client how to use a PCA system in the home. How will she explain to the client what he must do to self-manage pain?
A) “You don’t have to do anything. The machine does it all.”
B) “I will teach your family what they need to do.”
C) “When you push the button, you will get the medicine.”
D) “The medicine is going into your body all the time.”
20.A middle-age client is complaining of acute joint pain to a nurse who is assessing the client’s pain in a clinic. Which of the following questions related to pain assessment should the nurse ask the client? A) Does your diet include red meat and poultry products?
B) Does your pain level change after taking medications?
C) Are your family members aware of your pain?
D) Have you thought of the effects of your condition on your family?
21.A client having acute pain tells the nurse that her pain has gradually reduced, but that she fears it could recur and become chronic. What is a characteristic of chronic pain? A) Chronic pain will lead to psychological imbalance.
B) Chronic pain has far-reaching effects on the client.
C) Chronic pain can be severe in its initial stages.
D) Chronic pain eases with healing and eventually disappears.
22.A nurse is assessing a client with arthritis. Which of the following should the nurse consider in the initial assessment of the client? A) Blood group
B) Anxiety level
C) Pain level
D) Glucose level
23. A nurse is caring for a client with acute back pain. When should the nurse assess the client’s pain?
A) Six hours after administering a prescribed analgesic
B) After the client is discharged from the health care facility
C) Once per day when the pain is a potential problem
D) Whenever the vital signs are measured and documented
24.A client has an order for a narcotic analgesic every three to four hours and he received his last dose three hours earlier. Which of the following actions is most appropriate for the nurse to take in response to the client’s request for pain medication on his first postoperative day? A) Provide the client with pain medication
B) Tell the client that the pain cannot be severe
C) Document and ask the client to wait one hour
D) Contact the physician for a change in medication
25. Besides controlling pain of the post-abdominal surgery client with narcotics, the nurse suggests to the client that he … A) focus on pain relief
B) use distraction
C) describe the pain
D) think about the next dose
26.The Joint Commission supports the client’s right to pain management, and published standards for assessment and management of pain in hospitals, ambulatory care settings, and home care settings (Joint Commission, 2008b). Which of the following are recommended guidelines for pain management? Select all that apply.
A) Teach all clients to use a pain rating scale.
B) Determine a pain-rating goal with each client.
C) Use pharmacologic pain relief measures first.
D) Manipulate factors that affect the pain experience.
E) Keep the primary care provider in charge of all pain relief measures.
27.The nurse talks with a client who states, “My primary care provider wants me to try a TENS unit for my pain. How can electricity decrease my pain?” Which of the following responses is most appropriate?
A) “The mild electrical impulses block the pain signal before it can reach the brain.”
B) “The electrode patches generate heat and decrease muscle tension.”
C) “The machine tricks the mind into believing the pain does not exist.”D) “The electricity produces numbness and alters tissue sensitivity.”
28.The nurse is caring for a client who is receiving morphine via a patient-controlled analgesia (PCA) pump. The nurse notes that the client’s respiratory rate is 10 breaths per minute. The client is somnolent, with minimal response to physical stimulation. The nurse should prepare to administer which of the following medications?
A) Intravenous naloxone (Narcan)
B) Intravenous flumazenil (Romazicon)
C) Oral modafinil (Provigil)
D) Nebulized albuterol (Proventil)
29.The nurse has just completed programming of a patient-controlled analgesia (PCA) pump using prescribed parameters.
Which of the following actions should you take next? A) Verify the settings with another nurse.
B) Document implementation of the PCA on the client’s chart.
C) Attach the PCA pump tubing to the client’s intravenous access device.
D) Check the pump’s electrical cords for cracks, splits, or fraying.
30.A nurse is ordered to apply a transcutaneous electrical nerve stimulation (TENS) unit to a client recovering from abdominal surgery. Which of the following is a consideration when using this device? A) TENS is an invasive technique for providing pain relief.
B)TENS involves the electrical stimulation of large-diameter fibers to inhibit the transmission of painful impulses carried over small-diameter fibers.
C) TENS is most beneficial when used to treat pain that is generalized.
D) A TENS unit is applied intermittently throughout the day and should not be worn for extended periods of time.
31.A nurse is assessing the vital signs of a client who is moaning due to the acute onset of pain. What would be the expected objective findings? A) Decreased pulse and respirations
B) Increased pulse and blood pressure
C) Increased temperature
D) No change from client’s norms
32.A nurse is assessing a mentally challenged, adult client who is in pain after a fall. Which of the following scales should the nurse use to assess the client’s pain?
A) Pain Assessment in Advanced Dementia (PAINAD)
B) Wong-Baker Faces scale
C) Linear Scale
D) Numeric Scale
33.The nurse is caring for a client with terminal bone cancer. The client states, My pain is getting worse and worse, and the morphine doesn’t help anymore. The nurse determines the client’s pain is which of the following? A) Acute
B) Chronic malignant
C) Diffuse
D) Intractable
34.A nurse asks a client to rate his pain on a scale of 0 to 10, with 0 being no pain and 10 being worst pain. What characteristic of pain is the nurse assessing?
A) Duration
B) Location
C) ChronologyD) Intensity
35.A mother calls the nurse practitioner to say, “I don’t know what is wrong with my baby. He cried all night and kept pulling at his ear.” How would the nurse respond?
A) “Oh, he probably was just hungry and wet. Did you feed him?”
B) “Babies at that age cry at night. Think nothing of it.”
C) “That means his ear hurt. Bring him in to be checked.”
D) “That probably means he had a tummy ache. How is he now?”
Chapter 35, Nutrition
1.A dietitian is providing an in-service for the nurses on a medical-surgical unit. During the in-service, she informs the group that there are six classes of nutrients, and three supply the body with energy. What are the three sources of energy?
A) Carbohydrates, protein, and lipids
B) Vitamins, minerals, and water
C) Carbohydrates, protein, and water
D) Lipids, vitamins, and minerals
2.In planning to meet the nutritional needs of a critically ill client in the intensive care unit, which factor will increase the client’s basal metabolic rate?
A) Infection
B) Advanced age
C) Prolonged fasting
D) Long periods of sleep
3.A client is interested in losing 15 pounds, and she informs the nurse she is counting her calorie intake each day. The client has a goal of losing one pound a week until she reaches her goal. The client asks the nurse how many calories she should decrease daily to lose a pound a week. What is the nurse’s best response?
A) 500 calories/day
B) 200 calories/day
C) 300 calories/day
D) 400 calories/day
4.The nurse caring for a client for several days has assessed that he has been eating poorly during his hospitalization.
Which nursing measure should the nurse implement to assist the client in improving his nutritional intake? A) Encourage his daughter to prepare food at home and bring it to the client.
B) Serve large meals and encourage the client to eat as much as possible.
C) Provide distractions while the client is fed so that he will eat more.
D) Provide bland meals.
5.Which of the following nutritional guidelines should a nurse provide to a client who is entering the second trimester of her pregnancy?
A) “You’ll need to eat more calories and to make sure you eat a balanced diet high in nutrients.”
B) “Try to eat your normal number of calories, but aim to eat a diet that’s higher in fruits and vegetables.”
C) “The more food energy you consume, the greater the chances that you will have a healthy pregnancy.”
D) “Maintain your regular calorie intake, but take some supplements and emphasize organic foods.”
6. The nurse is testing the blood glucose levels of a client with a history of diabetes. The nurse has performed hand hygiene, checked the order, informed the client and turned on the monitor. After removing a test strip from the vial, the nurse should do which of the following?
A) Confirm that the strip and the meter share the same code.
B) Massage the client’s finger toward the selected puncture site.
C) Cleanse the client’s finger with alcohol.
D) Pierce the client’s skin with the lancet.
7.A client is discussing weight loss with a nurse. The patient says, “I will not eat for two weeks, then I will lose at least 10 pounds.” What should the nurse tell the client?
A) “What a good idea. Go ahead. That will jump start your weight loss!”
B) “Many people find that to be an ideal way to lose weight quickly and easily.”
C) “That will increase your metabolic rate and help you lose weight.”
D) “That will decrease your metabolic rate and make weight loss more difficult.”
8. Which client will have an increased metabolic rate and require nutritional interventions?
A) A healthy young adult who works in an office
B) A retired person living in a temperate climate
C) A person with a serious infection and fever
D) An older, sedentary adult with painful joints
9.A nurse is helping a client design a weight-loss diet. To lose one pound of fat (3,500 calories) per week, how many calories should be decreased each day?
A) 100
B) 250
C) 500
D) 1,000
10.A hospitalized client has been NPO with only intravenous fluid intake for a prolonged period. What assessments might indicate protein-calorie malnutrition? A) Fever, joint pain, dehydration
B) Poor wound healing, apathy, edema
C) Sleep disturbances, anger, increased output
D) Weight gain, visual deficits, erythema of skin
11. How often would a nurse recommend a client eat or drink a source of vitamin C?
A) Once a week
B) Once a month
C) Three times a weekD) Every day
12.While reviewing an adult client’s chart, a nurse notes average daily intake of fluids as 2,000 mL/day. What will the nurse do based on this information?
A) Change the plan of care to include forcing fluids.
B) Ask the client to drink more water during the day.
C) Post a sign limiting fluids to 1,000 mL every 24 hours.
D) Continue with care; this is a normal fluid intake.
13. A nurse has documented that a client has anorexia. What does this term mean?
A) Eating more than daily requirements
B) Lack of appetite
C) Vitamin C deficiency
D) Fluid deficit
14.A nurse is discussing infant care with a woman who just had a baby girl. What type of nutrition would the nurse recommend for the infant? A) Solid foods after the first month
B) No solid foods until age 1 year
C) Bottle feeding with cow’s milk
D) Breast-feeding or formula with iron
15. What information do anthropometric measurements provide in adults?
A) Indirect measure of protein and fat stores
B) Direct measure of degree of obesity
C) Indication of degree of growth rate
D) Reflection of social interaction with others
16. What independent nursing intervention can be implemented to stimulate appetite? A) Administer prescribed medications.
B) Recommend dietary supplements.
C) Encourage or provide oral care.
D) Assess manifestations of malnutrition.
17. A nurse is feeding a client. Which of the following statements would help a person maintain dignity while being fed?
A) “I am going to feed you your cereal first, and then your eggs.”
B) “I wish I had more time so I could feed you all of your meal.”
C) “I know you don’t like me to feed you, but you need to eat.”
D) “What part of your dinner would you like to eat first?”
18. A client has been prescribed a clear liquid diet. What food or fluids will be served?
A) Milk, frozen dessert, egg substitutes
B) High-calorie, high-protein supplements
C) Hot cereals, ice cream, chocolate milk
D) Jell-O, carbonated beverages, apple juice
19. What is the route of administration for TPN?
A) Oral
B) Subcutaneous
C) IntramuscularD) Intravenous
20.A nurse is caring for a client with a history of cardiac and vascular disease. Which of the following fats should the nurse allow in the client’s diet for his condition?
A) Unsaturated fats
B) Trans fats
C) Saturated fats
D) Hydrogenated fats
21.A client visits a health care facility with complaints of loss of appetite following a prolonged illness. How should the nurse document the client’s condition?
A) Emaciation
B) Cachexia
C) AnorexiaD) Nausea
22.A nurse is caring for a client with excessive abdominal fat. Which of the following is a risk associated with excessive abdominal fat about which the nurse should inform the client?
A) Emaciation
B) Cachexia
C) Cardiovascular diseaseD) Anorexia
23.A nurse is caring for a young adult female client who has a folic acid defiency. When teaching the client about this condition, the nurse would include a discussion about the client’s increased risk for which of the following?
A) Neural tube deficits in the fetus
B) Inadequate absorption of calcium and phosphorus
C) Hemolysis of red blood cells
D) Impaired neuromuscular functioning
24.To promote health of the fetus, the nurse should instruct the woman in the first trimester of pregnancy to do which of the following?
A) Eliminate high-fiber foods
B) Eat foods high in folic acid
C) Consume saturated fats
D) Consume milk products in the last trimester
25.A nurse researching a diet for a client with diabetes includes foods that supply energy to the body. Which of the following are classes of nutrients that supply this energy? Select all that apply.
A) Vitamins
B) Proteins
C) Fats
D) Minerals
E) Carbohydrates
26. Which of the following factors increase BMR? Select all that apply.
A) Growth
B) Infections
C) Fever
D) Emotional tension
E) Aging
27. Which of the following are signs and symptoms of poor nutritional status?
A) Flaky facial skin, facial edema, pale skin color
B) Tongue is a deep red in color with surface papillae present.
C) Firm, pink nailbeds
D) Firm hair that is resistant to plucking
28. Which of the following laboratory results indicates the presence of malnutrition?
A) Serum albumin 2.8 g/dL
B) Hemoglobin (Hgb) 11.3 g/dL
C) Creatinine 1.9 mg/dL
D) Hematocrit (Hct) 56%
29.A nutritionist helps to plan a diet for a client with diabetes. Which of the following foods is a carbohydrate that should be included to help improve glucose tolerance?
A) Milk
B) Eggs
C) OatmealD) Nuts
30.A nurse calculates the BMI of a client during a general survey as 26. Under which of the following categories would this client fall?
A) Underweight
B) Normal
C) Overweight
D) Obesity Class I
31.A nurse is caring for a client with complaints of chest pain. Which of the following test results would indicate whether the client is at risk for cardiac disease? A) Test results of levels of unsaturated fats
B) Test results for dyslipidemia
C) Test results of levels of balanced proteins
D) Test results of levels of calories in each food intake
32. For which of the following clients should the nurse anticipate the need for a pureed diet?
A) A man whose stroke has resulted in difficulty swallowing
B) A woman who has required gallbladder surgery
C) A man with dementia who is unable to follow instructions
D) An obese woman after bariatric surgery
33.A nurse performing a nutritional assessment determines that the BMI of a 5’11” (1.8 meters) male client who weighs 81 kilograms is which of the following?
A) 25.1
B) 18.5
C) 20.3
D) 28.6
34.Most nutritionists recommend increasing fiber in the diet. In addition to other benefits, how does fiber affect cholesterol?
A) Increases fecal excretion of cholesterol
B) Decreases fecal excretion of cholesterol
C) Facilitates intake and use of trans fat
D) Raises blood cholesterol levels
35.The nurse prepares to administer an intermittent feeding to a client who has a nasogastric feeding tube. Arrange the following steps in the correct order
1. Verify correct tube placement.
2. Position client with head of bed elevated 30 to 45° degrees
3. Aspirate all gastric contents.
4. Flush tube with 30 mL water.
5. Verify that residual volume is less than 400 mL.
6. Administer feeding.
A) 1, 2, 3, 4, 5, 6
B) 2, 1, 3, 5, 4, 6
C) 2, 3, 1, 4, 6, 5
D) 1, 3, 2, 4, 5, 6
E) 1, 4, 2, 3, 5, 6
Chapter 36, Urinary Elimination
1. During a visit to the pediatrician’s office, a parent inquires about toilet training her daughter age 2 years. The nurse
informs the mother that one factor in determining toilet-training readiness is when … A) the child can recognize bladder fullness.
B) the child can hold the urine for four to five hours.
C) The child cannot control urination until seated on the toilet.
D) The child ignores the desire to void.
2.A client with urine retention related to a complete prostatic obstruction requires a urinary catheter to drain the bladder. Which type of catheter is most appropriate for a client that has an obstructed urethra?
A) Suprapubic catheter
B) Indwelling urethral catheter
C) Intermittent urethral catheterD) Straight catheter
3.A patient has developed edema in her lower legs and feet, prompting her physician to prescribe furosemide (Lasix), a diuretic medication. After the client has begun this new medication, what should the nurse anticipate?
A) Increased output of dilute urine
B) Increased urine concentration
C) A risk of urinary tract infections
D) Transient incontinence and increased urine production
4.A nurse is preparing to catheterize a female client. What will the nurse consider when comparing the anatomy of the female urethra with that of the male urethra?
A) Has different innervation
B) No connection with bladder
C) Shorter in length
D) Longer in length
5. Which of the following describes the term micturition?
A) Emptying the bladder
B) Catheterizing the bladder
C) Collecting a urine specimen
D) Experiencing total incontinence
6.A nurse working in a community pediatric clinic explains the process of toilet training to mothers of toddlers. Which is a recommended guideline for initiating this training?
A) The child should be able to hold urine for four hours.
B) The child should be between 18 and 24 months old.
C) The child should be able to communicate the need to void.
D) The child does not need the desire to gain control of voiding.
7.A nurse is caring for older adult clients in an assisted-living facility. Which effect of aging should the nurse consider when performing a urinary assessment?
A) The diminished ability of the kidneys to concentrate urine may result in urinary tract infection.
B) Increased bladder muscle tone may reduce the capacity of the bladder to hold urine, resulting in frequency.
C) Decreased bladder contractility may lead to urine retention and stasis, which increase the likelihood of urinary tractinfection.
D) Neuromuscular problems may result in the client finding urinary control too much trouble, resulting in incontinence.
8.A nurse is assessing the urine output of a client with Parkinson’s disease who is on levodopa. Which of the following is a common finding for a client on this medication? A) The urine may be brown or black.
B) The urine may be blood-tinged.
C) The urine may be green or blue-green.
D) The urine may be orange or orange-red.
9. A client tells the nurse, “Every time I sneeze, I wet my pants.” What is this type of involuntary escape of urine called? A) Urinary incontinence
B) Urinary incompetence
C) Normal micturition
D) Uncontrolled voiding
10.During a health history interview, a male client tells the nurse that he does not feel that he completely empties his bladder when he voids. He has been diagnosed with an enlarged prostate. What is the name of this symptom? A) Urinary incontinence
B) Urinary retention
C) Involuntary voiding
D) Urinary frequency
11. A nurse is assessing the urine on a newborn’s diaper. What would be a normal assessment finding?
A) Scanty to no urine
B) Highly concentrated urine
C) Light in color and odorlessD) Dark in color and odorous
12.An older woman who is a resident of a long-term care facility has to get up and void several times during the night. This can be the result of what physiologic change with normal aging? A) Diminished kidney ability to concentrate urine
B) Increased bladder muscle tone causing urinary frequency
C) Increased bladder contractility causing urinary stasis
D) Decreased intake of fluids during daytime hours
13.After surgery, a postoperative client has not voided for eight hours. Where would the nurse assess the bladder for distention?
A) Between the symphysis pubis and the umbilicus
B) Over the costovertebral region of the flankC) In the left lower quadrant of the abdomen
D) Between ribs 11 and 12 and the umbilicus
14.A nurse is delegating the collection of urinary output to an assistant. What should the nurse tell the assistant to do while measuring the urine?
A) Compare the amount of output with intake.
B) Use a clean measuring cup for each voiding.
C) Tell the client to wash the urethra before voiding.
D) Wear gloves when handling a client’s urine.
15.A nurse has instructed a client at the clinic about collecting a specimen for a routine urinalysis. The client makes the following statements. Which one indicates a need for more teaching?
A) “I need to tell you that I am having my menstrual period.”
B) “I will void into the specimen bottle you gave me.”
C) “I will keep the toilet paper in the specimen.”
D) “I will be sure that no stool is included in my urine.”
16.A student is collecting a sterile urine specimen from an indwelling catheter. How will the student correctly obtain the specimen?
A) Pour urine from the collecting bag.
B) Remove the catheter and ask the client to void.
C) Aspirate urine from the collecting bag.
D) Aspirate urine from the collection port.
17.A nurse is initiating a 24-hour urine collection for a client at home. What will be the first thing the nurse will ask the client to do at the beginning of the specimen collection? A) Void and discard the urine.
B) Begin the collection at a specific time.
C) Add the first voiding to the specimen.
D) Keep the urine warm during collection.
18.An older adult woman has constant dribbling of urine. The associated discomfort, odor, and embarrassment may support which of the following nursing diagnoses?
A) Social Isolation
B) Impaired Adjustment
C) Defensive CopingD) Impaired Memory
19.A male client who has had outpatient surgery is unable to void while lying supine. What can the nurse do to facilitate his voiding?
A) Assist him to a standing position.
B) Tell him he has to void to be discharged.
C) Pour cold water over his genitalia.
D) Ask his wife to assist with the urinal.
20.A nurse is educating a client on the amount of water to drink each day. What is the recommended daily fluid intake for adults?
A) 1 to 2 (4-oz) glasses per day
B) 5 to 6 (6-oz) glasses per day
C) 8 to 10 (8-oz) glasses per day
D) 16 to 20 (12-oz) glasses per day
21. A nurse is carrying out an order to remove an indwelling catheter. What is the first step of this skill? A) Deflate the balloon by aspirating the fluid.
B) Ask the client to take several deep breaths.</